Stomach Cancer - Causes, Signs, Symptoms And Treatment Of Stage 4 Stomach Cancer. Surgery And Chemotherapy

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Causes, signs, symptoms and treatment of stomach cancer

Content:

• What is stomach cancer?

• Stomach cancer symptoms

  The very first symptoms

• Causes of stomach cancer
• Stages
• Inoperable cancer
• Stomach cancer types
• Diagnostics
• Treatment
• Juices for stomach cancer
• Diet for stomach cancer
• Prevention

What is stomach cancer?

Stomach cancer is a malignant transformation of the cells of the gastric epithelium. In 71-95% of cases, the disease is associated with lesions of the stomach walls by Helicobacter Pylori bacteria and refers to common oncological diseases of people aged 50 to 70 years. In men, stomach cancer is diagnosed 10-20% more often than in women of the same age.

Epidemiology

In the structure of oncological diseases in Russia, stomach cancer occupies a leading position, together with malignant lesions of the lung, breast, colon and skin.

The incidence rate is 17-19 people per 100 thousand inhabitants of Russia per year. According to some reports, it reaches 30 people per 100 thousand of the population. The duration of the preclinical period of the disease is from 11 months to 6 years.

There is a geographical heterogeneity of the incidence rate on a global scale:

• High level - Russia, Japan, South Korea, Finland, Chile, Brazil, Colombia, Iceland.
• Low level - Western Europe, USA, Canada, Australia, Indonesia.

The debut of gastric cancer is associated with H. pylori and previous pathologies: dysplasia of the mucous membranes, peptic ulcer disease, polyps on the walls of the stomach, gastritis and other diseases. The negative effect of smoking and strong alcohol on the body, as well as the regular use of food colors, flavors and flavor enhancers has been undoubtedly proven.

In countries with a high level of medical care, cancer is detected at an early stage, so the mortality statistics looks quite optimistic. The five-year survival rate for gastric cancer patients in Japan, subject to early diagnosis, is about 70-90%.

How long do you live with stomach cancer?

Men with stomach cancer live on average 12 years, and women 15 years less than their peers.

In Russia, the structure of detection and survival of patients is as follows:

• Stage I of the disease is determined in 10-20% of patients, survival rate within five years is 60-80%;
• Stage II-III with lesions of regional lymph nodes is determined in 30% of patients, the survival rate within five years fluctuates at the level of 15-45%;
• Stage IV with metastases to neighboring organs is diagnosed in 50% of patients, the survival rate within five years is no more than 5-7%.

Active attempts are being made to create systems for objective prognosis of the disease outcome. As immunohistochemical markers of this form, oncologists use various enzyme systems, including MMP-9. The method finds application in clinical oncology to determine the possibility of surgical treatment.

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Stomach cancer symptoms

The disease does not show clinical signs for a long time.

The main diagnostic errors are associated with symptoms that make gastric cancer similar to non-cancer pathologies of the heart or gastrointestinal tract:

• Similar to heart disease. Localization of the tumor in the cardiac part of the stomach is accompanied by chest pain (angina pectoris), especially against the background of high blood pressure in people after fifty years.
• Similar to diseases of the gastrointestinal tract. Localization of the tumor closer to the intestinal part of the stomach is manifested by signs resembling gastritis, peptic ulcer, pancreatitis, cholecystitis. All of these diseases are manifested by abdominal pain, vomiting, and stomach bleeding.

An erroneous diagnosis can hide the underlying disease for a long time. Moreover, during an in-depth examination, a cardiologist and a gastroenterologist usually find multiple abnormalities in elderly patients, while there are no obvious signs of oncology.

The doctor leading the patient should be alerted:

• Lack of effect after a course of treatment;
• The patient has a history of chronic diseases of the gastrointestinal tract.

The patient and the doctor should also be concerned about subjective sensations (at least two or three), indicating signs of small stomach cancer:

• Constant discomfort in the abdomen (overflow, heaviness);
• Difficulty swallowing food, chest pain that radiates to the back;
• Pain that does not subside after eating and is not relieved by taking medications;
• Fatigue and chronic weakness after minimal physical activity;
• Rapid weight loss (by 10-20 kg in 6 months with a body weight of 80-90 kg) and decreased appetite;
• Aversion to meat dishes, not previously observed pickiness in food;
• Fast satiation with a minimal amount of food.

On the basis of clinical studies, the regularities of the appearance of signs of the disease (at least two or three of the following) have been established, which are further identified as signs of oncology, namely:

• Pain in the central epigastric region, reported by about 60% of patients;
• Progressive weight loss, reported by about 50% of patients;
• Nausea and vomiting after eating - about 40% of patients;
• Nausea and vomiting with blood - about 25%;
• The pallor of the mucous membranes is about 40%.

Clinical symptoms have some differences depending on the location of the tumor in the upper, middle and lower parts of the stomach:

• The defeat of the upper part of the stomach is manifested by cardiac symptoms (pain in the region of the heart), as well as difficulty in swallowing, up to the inability to eat. Dehydration develops, threatening the syndrome of disseminated intravascular coagulation (DIC). Protein starvation is also dangerous, which aggravates the disturbances of nitrogen metabolism and leads to a critical level of under-oxidized substances in the blood.
• The defeat of the middle part of the stomach is manifested by gastric bleeding and the development of anemia. Large vessels are located in this zone. Latent bleeding is determined by simple laboratory methods, and massive bleeding is determined by a change in the consistency and color of feces - it becomes black and tarry. Pain is most often associated with involvement of the pancreas in carcinogenesis. Other symptoms are general.
• The defeat of the lower stomach is manifested by dyspepsia (diarrhea, constipation, vomiting and stomach pain), belching with the smell of rotten eggs.

The very first symptoms of stomach cancer

The first signs should be paid attention long before the symptoms characterizing the III-IV stages of gastric cancer. Revealing the disease in the last stages is almost a sentence to the patient.

The following pathologies should be associated with precancerous diseases:

• Chronic (atrophic) gastritis, regardless of the reasons, is characterized by uniform signs that are well detected during the clinical examination of the patient - nausea and vomiting.
• A stomach ulcer, regardless of the options, is manifested by gastric bleeding in the form of bloody vomiting, massive or latent blood loss during bowel movements, constant or recurrent pain in the stomach. Peptic ulcer disease is characterized by seasonal exacerbations and successful pain relief with medication.
• Polyps of the stomach walls, including large (adenomatous) and small (hyperplastic). The early stages are subclinical, benign neoplasms bleed during trauma. Polyps located in the initial section of the stomach are prone to malignancy.
• Dysplasia, metaplasia. All stages of cellular atypia (dysplasia) up to the last stage IV (cancer in situ) are detected mainly by laboratory methods during cytological and histological examination. In the last stages, digestive disorders, nausea and vomiting are diagnosed.

Vomiting with stomach cancer

At first glance, unmotivated vomiting may indicate early signs of oncology. Vomiting in combination with other signs is of diagnostic value.

The gag reflex can be triggered by:

• Narrowing of the digestive tube by a developed tumor, which creates an obstacle to the advancement of food (has diagnostic value in the later stages);
• Irritation of the receptors of the vomiting center during chemical and mechanical action of the products of pathogenesis (it is of great diagnostic value, including in the early stages).

In the first case, food is thrown out directly after eating. Vomit contains swallowed food without signs of digestion by gastric juice. Concomitant symptoms that indicate cancer of the digestive tube are sudden weight loss, pallor of the mucous membranes, and changes in the walls of the stomach at the cellular level. Vomiting of undigested food is observed in case of intoxication for a short period of time. But if it is associated with stomach cancer, then it manifests itself for a long time.

In the second case, with irritation of the vomiting center, vomiting occurs regardless of food intake. Most often it is associated with intoxication of the body with carcinogenesis products.

With a single spasm, vomiting contains half-digested, with multiple spasms - liquid contents:

• Yellow (bile ducts are normal);
• Light-colored (obstruction of the ducts, possibly liver metastasis);
• Dark red veins or clots (damage to blood vessels).

Vomiting and cancer are definitely linked in the presence of two or three additional signs of damage to the digestive tract.

Blood for stomach cancer

Changes are observed in feces (in the form of melena - the so-called `` currant jelly ''), as well as in vomit. Gastric bleeding is not always associated with cancer. The combination of bleeding and minor signs of stomach cancer (see above) significantly increases the likelihood of being associated with an underlying disease.

Signs of gastric bleeding:

• The vomit is dark in color and does not foam, this distinguishes blood from the stomach from pulmonary bleeding;
• The feces due to clotted blood are black, the consistency is liquid, the smell is fetid, and is released in small portions.

Causes of stomach cancer

The transformation of normal cells into malignant cells is a multi-stage chain of events.

The following is a simplified view of carcinogenesis and the stepwise inclusion of a variety of causes:

• Stimulation and accumulation of mutations under the influence of external and / or internal carcinogens;
• Development of precancerous diseases in the walls of the stomach (chronic gastritis, peptic ulcer disease, benign neoplastic formations);
• Stimulation of the development of oncology against the background of precancer and exposure to carcinogens.

First stage

For mutations to occur, a carcinogenic effect on the epithelium of the stomach is necessary.

External carcinogens (mainly food and drink), including:

• Excessive regular use of table salt, food additives marked "E". For example, meat products and delicacies, which are always (provided by the technology) add sodium nitrate E251 to give the meat a red color, monosodium glutamate or E261 to improve the taste. Smoked, spicy, pickled, canned and fried foods, strong alcohol, tobacco smoking, drug use (aspirin, hormones) also contribute to stomach cancer;
• The lack of ascorbic acid (vitamin C), which normalizes the level and quality of hydrochloric acid, reduces bleeding, thereby preventing the development of primary disorders in the walls of the stomach. Low levels of vitamin E (tocopherol), which regulates the resistance of mucous membranes, beta-carotene and some macro and microelements, are also detrimental.

Internal carcinogens (infectious, hereditary, immune factors), including:

• Infectious - the negative effect of Helicobacter pylori, micrococci, streptococci and staphylococci, fungi of the genus Candida, Epstein-Barr virus. The participation of the latter as a cause of stomach cancer has been undoubtedly proven by the detection of herpes markers in tumor cells of some types of tumors;
• Hereditary - it has been proven that the incidence of certain forms of cancer is 20% higher in persons inheriting the A (II) blood group. The hereditary transmission of a low level of a gene called E-cadherin, an epithelial protein that normally inhibits the growth of tumor cells, has also been confirmed;
• Immune - a decrease in the resistance of the epithelium due to a lack of immunoglobulin (Ig) A in the wall of the mucous membranes. The influence of autoimmune processes on the formation of cancer has also been proven.

Second phase

Includes the development of pre-cancer conditions, including:

• Chronic gastritis;
• Stomach ulcers;
• Polyps of the stomach walls;
• Resection of the stomach and other stomach operations;
• Dysplasia and metaplasia of the stomach walls.

Diseases can develop without the participation of carcinogens, then the pathogenesis is limited to a benign course. In the case of their impact, the disease is transformed into a malignant one.

Stage three

Carcinogenesis is triggered directly by a combination of the above two factors and unknown additional causes. The underlying mechanisms of transformation of normal cells into malignant ones are not fully understood. However, it is known that almost 100% of gastric cancer cases are preceded by H. pylori infection, damage to the stomach walls, and the unconditional participation of carcinogens.

Stages of stomach cancer

The designation of the primary tumor is T with the addition of numbers from 1 to 4 and small capital letters (a, b) to describe the details of carcinogenesis occurring in the primary tumor. The designation of the lesion of regional lymph nodes is N with the addition of numbers from 0 to 3 and small capital letters (a, b). To designate distant metastases, use the Latin letter - M and numbers - 0, 1 to indicate the absence or presence of distant metastases.

Stage 1 stomach cancer

Stage 1 can be encrypted in three ways, namely:

• stage 1A (T ₁ N ₀ M ₀), the primary tumor of the first stage, grows into the mucous and submucous layer, without affecting the lymph nodes and distant metastases;
• stage 1B, option 1 (T ₁ N ₁ M ₀), the primary tumor grows into the mucous and submucous layer, metastases in one to six regional lymph nodes, distant metastases are absent;
• stage 1 B, option 2 (T _{2a / b} N ₀ M ₀), the primary tumor has grown into the muscle and sub-serous layer, no damage to the lymph nodes or distant metastases is observed.

Stage 2 stomach cancer

Stage 2 can be encrypted in three ways, namely:

• (T ₁ N ₂ M ₀), the primary tumor grows into the mucous and submucous layer, the involvement of 7-15 regional lymph nodes occurs, there are no distant metastases;
• (T _{2a / b} N ₁ M ₀), a primary tumor in the muscle and sub-serous layer, the involvement of 1-6 regional lymph nodes and the absence of distant metastases are diagnosed;
• (T ₃ N ₀ M ₀), the primary tumor is located in the serous membrane and the visceral wall without involvement of neighboring organs, lesions of regional lymph nodes and distant metastases are not observed.

Stage 3 stomach cancer

Stage 3 can be encrypted in four ways, namely:

• Stage IIIA, option 1 (T _{2a / b} N ₂ M ₀), which means the involvement of the muscle and sub-serous layer of the stomach wall in the pathogenesis, the defeat of 7-15 regional lymph nodes and the absence of distant metastases;
• Stage IIIA, option 2 (T ₃ N ₁ M ₀), means damage to all layers of the serous membrane of the stomach without involving neighboring organs, damage to 1-6 regional lymph nodes and the absence of distant metastases;
• Stage IIIA, option 3 (T ₄ N ₀ M ₀), the tumor has spread to neighboring organs in the absence of lesions of regional lymph nodes and without distant metastases;
• Stage IIIB, (T ₃ N ₂ M ₀₎, damage to all layers of the serous membrane, damage to 7-15 regional lymph nodes, absence of distant metastases;

Stage 4 stomach cancer

Stage 4 can be encrypted in three main ways, namely:

• (T ₄ N _1, N _2, N _3, M ₀), tumor spread to neighboring organs, damage to regional lymph nodes (1-6) –N ₁, or (7-15) - N _2, or (more than 15) - N ₃, no distant metastases;
• (T ₁ T ₂ T ₃, N ₃ M ₀), damage to the mucous and submucosal layer - T ₁ or damage to the muscle and sub- serous layer - T ₂ or damage to all layers of the serous membrane, damage to more than 15 regional lymph nodes, absence of distant metastases;
• (T _any, N _any, M ₁), a primary tumor of various growth options, as well as any variants of lesions of regional lymph nodes and the obligatory presence of distant metastases.

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Inoperable gastric cancer with metastases

This designates the stage of the disease at which it is impossible or impractical to apply methods of surgical removal (resection) of a part of the stomach and lymph nodes in order to stop the disease. Inoperable cases do not include palliative operations in order to alleviate the patient's condition.

Inoperable cancer can be:

• Locally widespread, when a significant part of the stomach is damaged or multiple lesions are mosaic and affect vital parts of the body (large vessels, nerve nodes), cells spread lymphogenically, contact or implantation;
• Metastatic, when lesions of distant organs are detected, usually the liver, lungs, adrenal glands, bones and subcutaneous tissue. Cancer cells spread through the bloodstream.

The most positive results are observed with radical radiation therapy of locally advanced processes. According to some reports, life expectancy after a course of combined treatment can be increased to 20-24 months. In this case, complications from exposure to ionizing radiation are significantly lower than the therapeutic effect, and the patient gets a chance to prolong life in the absence of pain. Unfortunately, it is impossible to guarantee more in the conditions of modern medicine.

The main routes of metastasis pass through the lymphatic system, therefore, secondary neoplasms and the most significant metastases are found, first of all, in the lymph nodes.

Stomach cancer metastases:

• In pararectal tissue or in the space near the rectum - Schnitzler;
• In the navel - sisters Marie Joseph;
• In the left supraclavicular region - Virchova;
• In the area of the ovaries - Kruckenberg.

These secondary tumors are evidence of advanced stages of the disease, when the treatment strategy and tactics are selected individually and, most often, are palliative, that is, aimed at improving the patient's quality of life.

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Stomach cancer types

Stomach cancer is divided according to the site of localization and ways of spreading - this can be, for example, extrusion of the surrounding tissues or, conversely, infiltration into the surrounding tissues. Histological forms of cancer have a significant effect on pathogenesis: diffuse or polypoid.

Cricoid gastric cancer

It is diagnosed by cytological and histological examination. This is a type of diffuse cancer. The altered area consists of flat cricoid cells. The disease is characterized by an aggressive course.

Histochemical studies have established the hormonal nature of this tumor. In the tissues of the neoplasm, an increase in the level of estrogen is found in women, and in men - testosterone.

A distinctive feature of this type of disease:

• The predominance of women in the structure of patients. The number of sick women - 55%, men - 45%. The ratio may vary, but the pattern has been confirmed by numerous studies;
• The incidence peaks in the age range from 40 to 50 years and 60-70 years. In other intervals of life, such cancer is diagnosed significantly lower;
• The structure of patients is dominated by people with blood group A (II) - about 45%, with other variants of blood groups significantly lower.
• The dependence of the onset of the disease on the presence of previous bad habits (consumption of alcohol, salted, smoked, pickled food) and exogenous factors (work with radiation, in chemical production) has not been established.
• This type of stomach cancer is more commonly found in urban residents.

Infiltrative gastric cancer

The morphological form of carcinoma, without a clear definition of the boundaries of the neoplasm. The growth of malignant cells occurs mainly in the thickness of the stomach wall.

Features of the disease:

• Can occur in relatively young people, a hereditary predisposition is noticeable;
• Small foci of tumor cell growth are found at a distance of 5-7 cm from each other;
• This is one of the most malignant forms of cancer, often metastatic;
• The pathogenesis of the clinical stage is accompanied by symptoms associated with dyspeptic symptoms (chronic vomiting, impaired peristalsis);
• In the last stages, the tumor is defined as a dense stone-like formation, the stomach decreases in size.

Poorly differentiated stomach cancer

Normal epithelial cells are renewed at a high rate, after about 3-4 days the generation is completely replaced. High update rates are an important factor in the appearance of defects.

The high rate of reproduction of poorly differentiated cells underlies the aggressive pathogenesis of cancer. Low-grade gastric cancer is a form of gastric adenocarcinoma made up of stem cells.

Features of the disease:

• High growth rate, development of inflammatory and necrotic foci around the tumor;
• Inability to determine the type of changes latent development of carcinogenesis in the thickness of the stomach wall;
• The absence of clear boundaries of the tumor, growth occurs according to the type of diffuse impregnation of the walls of the stomach;
• Rapid formation of metastases in regional lymph nodes and distant organs: metastasis reaches 90% of all cases of poorly differentiated oncogenesis.

Diagnosis of stomach cancer

Of particular importance for the early detection of the disease is the vigilance and attentiveness of the general practitioner. Diagnostics is carried out in stages and includes physical, instrumental and laboratory methods.

1. Physical methods

Diagnosis begins with clinical examination, palpation, and auscultation.

In the early stages of stomach cancer, it allows you to identify distant signs of the disease by the condition of the skin, color, humidity, temperature, pain, including in the abdomen.

With auscultation of the heart, chest pain is a common complaint of the patient. Noises of stenosis and splashing, which are not characteristic of pathologies of the cardiovascular system, should be excluded. On palpation of the abdominal wall in the early stages of the disease, there are no changes, and in the later stages, seals under the skin in the epigastric region can be found.

2. Instrumental methods

The methods of contrast X-ray diagnostics, as well as endoscopy, are used.

X-ray diagnostics. It is an indirect method that helps to quickly determine the presence of pathology by the nature of the X-ray shadow.

The radiologist takes into account the following changes in the negative image, where dense are light areas and loose are dark areas:

• Local change (thickening, folding) of the wall;
• Defects of various sizes in the form of filled areas on the contour of the inner wall in polypoid forms of stomach cancer;
• Lumps, decreased elasticity of the stomach tissue;
• Niches with a zone of infiltration and folding of the walls of the mucous membranes;
• Deformations in the form of pushing back sections of the walls around the tumor or impregnation of the tissues of the stomach walls;
• Decreased peristalsis (not determined by all methods).

Modern methods of X-ray diagnostics allow indirectly, by the nature of darkening, to reveal up to 85% of changes in the walls of the stomach. A more valuable diagnostic method for stomach oncologists is endoscopy.

Gastroendoscopy

The value increases when biopsy samples are obtained from various parts of the stomach wall for histological and cytological examination. Color visualization of the walls of the organ helps to identify minimal deviations from the norm in the nature of the color of the inner walls, the thickness of the folds, the presence of gastric peristalsis and foci of bleeding, in the shape of the wall defect (raised, undermined, deepened).

Gastroendoscopy modifications:

• Staining helps to identify areas of metaplasia and other early pathologies that are not visible to the naked eye;
• Treatment with drugs that selectively accumulate in tumor cells, with laser illumination, helps to identify the altered area by fluorescence;
• Endoscopy with optical zoom tips helps to identify changes in the walls of the stomach at the cellular level;
• Endoscopes with ultrasound tips - a combination of ultrasound and imaging;
• A relatively new method is the introduction of an uncontrolled video capsule into the stomach, which in real time shows an overview, non-sighting picture of the stomach wall.

Disadvantages of endoscopy:

• Patient feels uncomfortable when swallowing a relatively large tube. This is usually accompanied by a reflex gag reflex, which is prevented with the help of drugs (deprivan, cerucal);
• Difficulty differentiating benign and malignant tumors.

Therefore, endoscopy is usually combined with electrocoagulation of neoplasms on the walls of the stomach.

Morphological method

Based on the histological and cytological examination in the laboratory, the histological type of the tumor is determined with a high degree of reliability. General pattern: tumors located closer to the cardiac part (the entrance to the stomach) are more likely to have malignant properties.

3. Additional methods

Ultrasound diagnostics. It is carried out in three main variants:

• Outside, through the abdominal wall;
• Outside, after filling the stomach with degassed fluid;
• From the inside, using an endoscopic probe.

Laparoscopy is the second additional method for diagnosing stomach cancer. This technique is used to determine the operability of the tumor and the presence of metastases. Laboratory examination of biological fluids is used to clarify the patient's condition before surgery. In recent years, methods of determining cancer using tumor markers have been used.

Differential diagnosis of stomach cancer

The above methods are used to differentiate cancer from less dangerous or pre-cancer conditions, including:

• Atrophic forms of gastritis;
• Peptic ulcer;
• Various polyps;
• Infectious diseases with similar symptoms (syphilis, stomach tuberculosis, amyloidosis);
• Diseases of the lower esophagus (narrowing, achalasia - incomplete relaxation of the sphincter closer to the stomach).

Stomach cancer treatment

The choice of treatment tactics is determined by the stage of carcinogenesis and is discussed at a council with the participation of specialists from several medical specialties. The main treatment for early-stage tumors is surgical removal in combination with adjuvant and non-adjuvant chemotherapy. Advanced treatments are palliative and symptomatic.

All patients are conditionally divided into three groups:

• First, patients have early stages (patients with carcinoma in situ and first stage);
• The second - patients with operable locally advanced stage (corresponds to patients up to stage III);
• The third - patients with an inoperable stage of generalized gastric cancer (patients with stage IV who have severe concomitant symptoms or involvement of vital organs and systems in the oncological process correspond).

Sometimes even patients with early forms of oncology are recognized as inoperable, for example, with a tumor affecting vital parts of the body or the impossibility of performing an operation for other reasons.

The highest probability of complete recovery (up to 90% with a five-year survival rate) without significant consequences for the body in the first group of patients. The prognosis within the second group has a significant scatter, due to the many nuances of this stage of the disease. The minimum favorable prognosis in patients of the latter, third group. In this case, we should talk about prolonging and improving the quality of life of patients during the period of illness.

Removal (resection) of the stomach for cancer

Patients, with the exception of some categories, before the operation are shown laparoscopic diagnostics in order to exclude metastasis on the omentum and in the peritoneum.

Endoscopic resection

Depending on the stage of the disease, the clinical condition of the patient and the size of the tumor, an operation with minimal opening of the abdominal wall - endoscopic resection - can be prescribed. There are several options - the choice is up to the doctor.

Possible complications of endoscopic resection:

• Postoperative pain - relieved by drugs or dosed radiation;
• Perforation (complete, partial) of the walls of the stomach - eliminated by physical methods of exposure;
• Postoperative bleeding is controlled by physical methods and pharmaceuticals.

A simplified version of the intervention is cauterization of neoplasms by electrothermal or laser action on the walls of the stomach.

Abdominal surgery

It is carried out in the absence of absolute and relative contraindications. If it is impossible to perform a resection, the issue of chemotherapy or the use of radiation exposure to the tumor is decided in order to reduce carcinogenesis before further surgery.

With indications for surgery, preoperative preparation is carried out, which consists of a number of manipulations aimed at stabilizing the patient's condition.

Planning the operation algorithm includes the choice:

• Access to the tumor during the operation;
• The volume of surgical intervention in the organ;
• Tactics for removing packets of lymph nodes;
• Organ reconstruction method.

An important stage of treatment is postoperative recovery, which includes the imposition of drainage tubes to drain exudate. Patients, in the absence of complications, are allowed to sit down on the first day, and walk on the second day after the operation.

Contraindications to abdominal surgery for stomach cancer are violations:

• Hemodynamics in the form of instability of blood pressure and disseminated intravascular coagulation;
• Respiratory rhythm (respiratory arrhythmias).

Planned postoperative measures:

• Postoperative pain relief from the first days;
• Stimulation of intestinal peristalsis, on the third day;
• Enteral (through a tube and if necessary) nutrition with special mixtures, from the first days;
• Antibiotic therapy in the form of a four- or six-day course;
• The introduction of medicinal substances that reduce blood viscosity (according to indications).

All manipulations are carried out under the supervision of a doctor. There are limitations and contraindications. The need for additional therapeutic measures is determined individually. Removal of stitches - not earlier than 7 days after the intervention.

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Chemotherapy for stomach cancer

Surgery to completely cure stomach cancer is usually not enough. The patient is monitored for a long time to determine the clinical dynamics. During this period, chemotherapy is prescribed to eliminate hidden local foci of secondary carcinogenesis.

Chemotherapy has a general negative effect on the body. Its use is justified only if there is a real possibility of increasing the chances of recovery or at least improving the patient's quality of life.

Adjuvant chemotherapy: The term “adjuvant” means augmentation or addition. That is, this type is used after surgery, in contrast to non-adjuvant chemotherapy, which is used before surgery in order to reduce the size of the tumor before surgery. In recent years, attitudes towards adjuvant treatment have changed. Previously, this method of chemotherapy for stomach cancer was considered ineffective.

Such treatment is carried out in the form of polychemotherapy (exposure to several drugs) in two or three courses at different intervals. Pharmaceutical cytostatics are used in various combinations: Doxorubicin, Etoposide, Cisplatin, Fluorouracil, Mitomycin, Cisplatin and others.

Palliative chemotherapy. Another type of therapy that is used when partial or total removal of the stomach and affected lymph nodes is impossible.

Complications after chemotherapy are inevitable. Cytostatics inhibit the growth of malignant cells.

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But at the same time, side effects develop in the form of toxicosis, accompanied by:

• Recoverable hair loss;
• Toxic liver damage;
• Violation of hematopoiesis;
• Suppression of cooperation between humoral and cellular immunity.

Usually, these phenomena are completely eliminated in the course of restorative treatment.

Learn More: Chemotherapy for Stomach Cancer

Juices for stomach cancer

The disease is accompanied by the loss of large volumes of fluid by the body after repeated vomiting and gastric bleeding. With cancer, patients complain of decreased appetite due to loss of taste and smell, pain and other reasons.

Juices, especially with pulp, are almost always useful for patients, especially if they do not have edema. The recommended fluid intake is up to 2 liters per day. In addition to juices, you can drink milk, fermented milk products, teas, compotes, fruit drinks.

It is advisable to use juices freshly squeezed, with pulp, from:

• vegetables (carrots, beets, tomatoes, cabbage, celery, bell peppers, lettuce leaves);
• fruits (apples, pears);
• berries (currants, cherries, cranberries).

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As a raw material for juicing, it is better to use local fruits that have a set of nutrients familiar to the patient.

Juice value:

• Acidic - to increase acidity, since the walls of the stomach reduce the production of hydrochloric acid, as well as reduce the need for table salt and increase the threshold of the gag reflex. Sweet and sour juices have the best tonic effect;
• Sweet ones - they should saturate the body with vitamins, minerals, indigestible fiber, which is contained in the pulp and is necessary to improve peristalsis. Too sweet juices are best diluted with water;
• Slightly bitter - for example, from cabbage, turnips or grapefruit to stimulate appetite and peristalsis.

After consultation with your doctor, the amount of liquids, especially in the form of refreshing juices and fermented milk drinks:

• increase during a course of chemotherapy drugs, with dehydration, diarrhea and vomiting;
• reduce with edema, accumulation of ascites fluid in the pleural and abdominal cavity.

After a course of treatment of stomach cancer with chemotherapy, some patients are shown to take up to 20-30 ml of table wine instead of juice before meals. A small amount of wine has a stimulating and tonic effect, improves immunity and soothes.

A person needs fluid to remove metabolic products from the body, improve tissue nutrition, improve well-being and increase immunity.

Diet for stomach cancer

Therapeutic dietary food for stomach cancer performs the following tasks:

• Prevents weight loss through a balanced diet;
• Increases tolerance to aggressive anticancer treatments and reduces the risk of postoperative complications;
• Normalizes metabolism and minimizes its disturbances;
• Increases and maintains the body's resistance to physical activity;
• Supports immunity, prevents infections, including slow ones, developing against the background of immunodeficiency;
• Accelerates the regenerative activity of body tissues after partial or total resection of the stomach;
• Improves the quality indicators of life.

The principles of nutritional therapy for stomach cancer:

• Cooking methods - boiling, baking, stewing;
• The diet of patients is four to six times a day;
• An individual approach to nutrition - taking into account energy costs and the characteristics of metabolism, the introduction of proteins, including animal origin, fats, carbohydrates and liquids into the diet is carried out gradually.
• Correction of nutrition, taking into account the stages of treatment - is carried out in order to reduce the side effects of anticancer therapy.

Three variants of a diet for patients with stomach cancer are proposed, taking into account the characteristics of metabolism and body weight.

First option

- organization of nutrition for a patient with normal body weight in the absence of pronounced metabolic disorders:

• Energy value - no more than 2400 kilocalories per day;
• The total amount of protein is 90 grams, including animal protein - 45 grams;
• The total amount of fat - 80 grams, including vegetable - 30 grams;
• The total amount of carbohydrates is 330 grams.

Second option

- organization of nutrition for a patient with severe body weight deficiency, exhaustion, with visible metabolic disorders, as well as after operations, chemotherapy or radiation therapy:

• Energy value - no more than 3600 kilocalories per day;
• The total amount of protein is 140 grams, including animal protein - 70 grams;
• The total amount of fats is 120 grams, including vegetable fats - 40 grams;
• The total amount of carbohydrates is 500 grams.

Third option

- for patients with critical weight loss and laboratory-confirmed impairment of renal and liver excretory function:

• Energy value - no more than 2650 kilocalories per day;
• The total amount of protein is 60 grams, including animal protein - 30 grams;
• The total amount of fats is 90 grams, including vegetable fats - 30 grams;
• The total amount of carbohydrates is 400 grams.

Learn more: Nutrition for Stomach Cancer

Prevention of stomach cancer

They carry out work that includes general measures: raising the level of medical knowledge of the population, informing about the causes of stomach cancer.

General activities

Dialogue with the population:

• Explaining the danger of cancer and increasing the alertness of people;
• Description of the algorithm of actions in case of detection of the first signs of stomach cancer;
• Promotion of a healthy lifestyle.

Medical events

Work in this direction is carried out in risk groups. It consists of measures for the prevention and treatment of precancerous diseases.

It is necessary to carry out therapy against Helicobacter pylori bacteria before the development of precancerous changes in the body. This type of bacteria is the etiological factor in 71-95% of all cases of stomach cancer.

The risk group includes people with a history of:

• Genetic predisposition;
• Carriage of H. pylori;
• Stomach resection;
• Long period of work in hazardous and chemical industries;
• Chronic insufficiency of the production of hydrochloric acid in the stomach;
• Pernicious anemia;
• Autoimmune atrophic gastritis;
• Extensive atrophic gastritis with decreased secretion of hydrochloric acid;
• Adenoma of the stomach.

The author of the article: Bykov Evgeny Pavlovich | Oncologist, surgeon

Education: graduated from residency at the Russian Scientific Oncological Center. N. N. Blokhin "and received a diploma in the specialty" Oncologist"